U.S. patent application number 13/101997 was filed with the patent office on 2012-05-24 for method and tool for assembling a bone anchoring device.
Invention is credited to Lutz Biedermann, Berthold Dannecker, Wilfried Matthis.
Application Number | 20120124813 13/101997 |
Document ID | / |
Family ID | 42313901 |
Filed Date | 2012-05-24 |
United States Patent
Application |
20120124813 |
Kind Code |
A1 |
Biedermann; Lutz ; et
al. |
May 24, 2012 |
METHOD AND TOOL FOR ASSEMBLING A BONE ANCHORING DEVICE
Abstract
A method for assembling a bone anchoring device includes
inserting a bone anchoring element in a first holder of a tool and
inserting a receiving part in a second holder of the tool,
actuating the tool from a first configuration towards a second
configuration to insert a head of the bone anchoring element into
the receiving part; continuing actuation of the tool towards the
second configuration to move a locking ring and a receiving part
body of the receiving part relative to each other until the locking
ring assumes a second position with respect to the receiving part
body in which the locking ring is latched to the receiving part
body in a position where the locking ring compresses a portion of
the receiving part body to compress the head, such that the head is
held in and cannot be removed from the receiving part body and the
bone anchoring element is held adjustably at a first angular
position relative to the receiving part, and removing the attached
bone anchoring element and receiving part from the tool. The tool
is configured for the execution of the steps according to the
method.
Inventors: |
Biedermann; Lutz;
(VS-Villingen, DE) ; Matthis; Wilfried; (Weisweil,
DE) ; Dannecker; Berthold; (St. Georgen, DE) |
Family ID: |
42313901 |
Appl. No.: |
13/101997 |
Filed: |
May 5, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61416658 |
Nov 23, 2010 |
|
|
|
Current U.S.
Class: |
29/525.01 ;
29/281.3 |
Current CPC
Class: |
Y10T 29/49826 20150115;
A61B 17/866 20130101; Y10T 29/53974 20150115; A61B 17/7032
20130101; A61B 17/7037 20130101; Y10T 29/53978 20150115; Y10T
29/53796 20150115; Y10T 29/49947 20150115; Y10T 29/5397 20150115;
Y10T 29/53678 20150115; A61B 17/88 20130101; Y10T 29/49876
20150115; A61B 17/8685 20130101; A61B 2017/00526 20130101; A61B
17/7074 20130101 |
Class at
Publication: |
29/525.01 ;
29/281.3 |
International
Class: |
B23P 11/00 20060101
B23P011/00; B25B 27/00 20060101 B25B027/00 |
Foreign Application Data
Date |
Code |
Application Number |
Nov 23, 2010 |
EP |
10 192 278.9 |
Claims
1. A method for assembling a bone anchoring device, the bone
anchoring device comprising a bone anchoring element comprising a
shaft for anchoring in a bone and a head, and a receiving part for
receiving a rod for coupling the rod to the bone anchoring element,
the receiving part comprising a receiving part body for
accommodating the head of the bone anchoring element in a polyaxial
manner, and a locking ring in a first position around the receiving
part body, where the locking ring is latched to the receiving part
body and in a position in which the head of the bone anchoring
element can be introduced into the receiving part body and can
freely pivot therein, the method comprising: inserting the bone
anchoring element in a first holder of a tool and inserting the
receiving part in a second holder of the tool; actuating the tool
from a first configuration towards a second configuration to insert
the head of the bone anchoring element into the receiving part
body; continuing actuation of the tool towards the second
configuration to move the locking ring and the receiving part body
relative to each other until the locking ring assumes a second
position with respect to the receiving part body in which the
locking ring is latched to the receiving part body in a position
where the locking ring compresses a portion of the receiving part
body to compress the head, such that the head is held in and cannot
be removed from the receiving part body and the bone anchoring
element is held adjustably at a first angular position relative to
the receiving part; and removing the attached bone anchoring
element and receiving part from the tool.
2. The method of claim 1, wherein at least one of the insertion of
the head or the moving of the locking ring into the second position
produces an audible sound.
3. The method of claim 1, wherein a force needed to move the
locking ring and the receiving part body relative to each other
from the first position to the second position is greater than a
force needed to insert the head into the receiving part body.
4. The method of claim 1, wherein the receiving part body is
supported by a spring member in the tool when the head is
inserted.
5. The method of claim 4, wherein the receiving part body is
supported by the spring member of the tool and the locking ring is
supported by a main body of the tool when the locking ring and the
receiving part body are moved relative to each other.
6. The method of claim 5, wherein a force needed to compress the
spring member is greater than a force needed to insert the head
into the receiving part body and smaller than a force needed to
move the locking ring and the receiving part body relative to each
other.
7. The method of claim 1, wherein the receiving part body
comprises: a first end and a second end; a rod receiving portion
with a channel for receiving a rod, and a head receiving portion
for accommodating the head of the bone anchoring element, the head
receiving portion having an open end at the second end of the
receiving part body and being flexible so as to allow introduction
and clamping of the head, wherein the locking ring is positioned
around the head receiving portion, wherein when the locking ring is
in the first position, the head of the bone anchoring element can
be introduced into the head receiving portion, and wherein when the
locking ring is in the second position, the locking ring compresses
the head receiving portion.
8. The method of claim 7, wherein when the locking ring is in the
second position, the locking ring provides a first compression
force on the head receiving portion such that the head of the bone
anchoring element is not fully locked.
9. The method of claim 8, wherein the locking ring can assume a
third position with respect to the receiving part body in which the
locking ring compresses the head receiving portion with a second
compression force greater than the first compression force, such
that the head is fully locked in the head receiving portion.
10. The method of claim 7, wherein in the first position, the
locking ring is prevented from moving in an axial direction towards
the first end of the receiving part body, but is movable towards
the second end of the receiving part body by applying a force.
11. The method of claim 7, wherein the locking ring has a first
projection or a first recess which is configured to cooperate with
a corresponding first recess or first projection of the receiving
part body to latch the locking ring in the first position.
12. The method of claim 7, wherein in the second position, the
locking ring is prevented from moving in an axial direction towards
the first end of the receiving part body, but is movable towards
the second end of the receiving part body by applying a force.
13. The method of claim 1, wherein the shaft of the bone anchoring
element comprises a threaded portion and the head of the bone
anchoring element comprises a spherical outer surface portion.
14. The method of claim 1, wherein in the first configuration the
first and second holders of the tool are spaced apart a first
distance, and in the second configuration the first and second
holders of the tool are spaced apart a second distance that is less
than the first distance, and wherein the actuating of the tool
comprises moving one of the first holder or the second holder
towards the other one of the first holder or the second holder.
15. The method of claim 1, further comprising: inserting the shaft
of the bone anchoring element into a bone; applying a force on the
receiving part to move the bone anchoring element to a second
angular position relative to the receiving part, wherein in the
second angular position the receiving part is aligned with a rod;
inserting the rod into a rod receiving channel of the receiving
part body; and locking the rod in the receiving part and locking
the receiving part at the second angular position relative to the
bone anchoring element.
16. The method of claim 15, further comprising: attaching at least
one additional bone anchoring element and receiving part assembly
to the same bone or a different bone; aligning the receiving part
of the at least one additional assembly with the rod; locking the
rod in the receiving part and locking an angular position of the
receiving part relative to the bone anchoring element for each of
the at least one additional assembly.
17. A tool for assembling a bone anchoring device, the bone
anchoring device comprising a bone anchoring element with a head
and a shaft to be anchored in the bone and a receiving part
comprising a receiving part body and a locking ring, the tool
comprising: a first holder for holding a bone anchoring element;
and a second holder for holding a receiving part, wherein the first
and second holders are movable relative to each other, such that
when the first holder is holding a bone anchoring element and the
second holder is holding a receiving part, the movement between the
first and second holders is configured to press the bone anchoring
element against at least one of the receiving part body or the
locking ring, and wherein the tool comprises an abutment device
which is movable between a first position and a second position,
wherein when in the first position the abutment device is
configured to resist movement of the receiving part body with
respect to the second holder when the first holder is moved towards
the second holder to engage the bone anchoring element with the
receiving part body, and wherein after engagement of the bone
anchoring element with the receiving part body, the abutment device
is configured to move from the first position to the second
position while the second holder is configured to resist movement
of the locking ring when the first holder is moved further towards
the second holder such that a position of the locking ring relative
to the bone anchoring element with the engaged receiving part body
is adjusted.
18. The tool of claim 17, wherein the second holder comprises the
abutment device.
19. The tool of claim 17, wherein the abutment device comprises: a
main body having a first end, a second end, and a coaxial bore; a
sleeve configured to be movable in the bore; and a spring member in
the sleeve.
20. The tool of claim 19, wherein the spring member is biased when
the abutment device is in at least one of the first or the second
position.
21. The tool of claim 20, wherein the spring member is more biased
when the abutment device is in the second position than when the
abutment device is in the first position.
22. The tool of claim 19, wherein when the second holder is holding
a receiving part, a receiving part body of the receiving part is
supported by the sleeve when the abutment device is in the first
position.
23. The tool of claim 19, wherein when the second holder is holding
a receiving part, a receiving part body of the receiving part is
supported by the sleeve and a locking ring of the receiving part is
supported by the main body when the abutment device is in the
second position.
24. The tool of claim 19, wherein the sleeve is closed at an end
nearer to the first end of the main body.
25. The tool of claim 19, wherein the main body comprises a thread
at the second end, and wherein a screw is screwable into the thread
to support the spring member.
26. The tool of claim 17, wherein a head of a bone anchoring
element, a receiving part body and a locking ring configured for
use with the tool are configured such that a force needed to move
the locking ring and the receiving part body relative to each other
is greater than a force needed to insert the head into the
receiving part body.
27. The tool of claim 26, wherein the spring member is configured
such that a force needed to compress the spring member is greater
than the force needed to insert the head of the bone anchoring
element into the receiving part body and smaller than the force
needed to move the locking ring and the receiving part body
relative to each other.
28. A tool for assembling a bone anchoring device, the bone
anchoring device comprising a bone anchoring element with a head
and a shaft to be anchored in a bone, and a receiving part for
receiving a rod for coupling the rod to the bone anchoring element,
the receiving part comprising a receiving part body with a head
receiving portion for accommodating the head of the bone anchoring
element and a locking ring configured to be positioned around the
head receiving portion, the tool comprising: a first holder for
holding a bone anchoring element; and a second holder for holding a
receiving part, wherein the first and second holders are movable
relative to one another, wherein at least one of the first holder
or the second holder has an abutment device which is movable
between a first position and a second position by application of a
force in a direction parallel to a direction of the movement
between the first and second holders, the abutment device being
movable independent from the movement between the first and second
holders.
29. The tool of claim 28, wherein the second holder comprises the
abutment device.
30. The tool of claim 28, wherein the abutment device comprises: a
main body having a first end, a second end, and a coaxial bore; a
sleeve configured to be movable in the bore; and a spring member in
the sleeve.
31. The tool of claim 30, wherein the spring member is biased when
the abutment device is in at least one of the first or the second
position.
32. The tool of claim 30, wherein the sleeve is closed at an end
nearer to the first end of the main body.
33. The tool of claim 30, wherein the main body comprises a thread
at the second end, and wherein a screw is screwable into the thread
to support the spring member.
34. The tool of claim 28, wherein the tool further comprises an
insert for receiving the bone anchoring element, the insert
configured to be inserted into the first holder.
35. The tool of claim 34, wherein the first holder has a recess
configured to receive the insert.
36. The tool of claim 34, wherein the insert has at least two
recesses.
37. The tool of claim 36, wherein the recesses on the insert are
cylinder-shaped or U-shaped.
38. The tool of claim 36, wherein the recesses on the insert extend
over the whole length of the insert.
39. The tool of claim 34, wherein the insert is rotatable while in
the first holder.
40. The tool of claim 28, further comprising a handle and lever,
wherein the first holder or the second holder is connected to the
handle and lever and is configured to be moved towards the other
one of the first holder or the second holder by actuation of the
handle and lever.
41. The tool of claim 40, further comprising a frame, wherein a
position of the other one of the first holder or the second holder
is fixed with respect to the frame.
Description
CROSS-REFERENCE TO RELATED APPLICATION(S)
[0001] The present application claims priority to and the benefit
of U.S. Provisional Patent Application Ser. No. 61/416,658, filed
Nov. 23, 2010, the contents of which are hereby incorporated by
reference in their entirety, and claims priority from European
Patent Application EP 10 192 278.9, filed Nov. 23, 2010, the
contents of which are hereby incorporated by reference in their
entirety.
BACKGROUND
[0002] 1. Field of the Invention
[0003] The invention relates to a method and a tool for assembling
a bone anchoring device comprising a receiving part for receiving a
rod, and for coupling the rod to a bone anchoring element and such
a receiving part. The receiving part includes a receiving part body
and a locking ring. The locking ring can assume a first position in
which it is latched with respect to the receiving part body and in
which a head of the bone anchoring element can be inserted, and a
second position in which it is latched with respect to the
receiving part body and in which the bone anchoring element is held
in an adjustable angular position but is not fully locked. The bone
anchoring device can be realized, for example, in the form of a
polyaxial bone screw. The method of assembling includes the steps
of providing the receiving part body and the locking ring in the
first position, inserting the head and moving the locking ring to
the second position. The tool is configured for the execution of
the steps.
[0004] 2. Description of Related Art
[0005] WO 2007/038350 A2 discloses an apparatus for connecting a
bone anchor to a support rod, the apparatus including a connector
body and a cap. The connector body has a socket for insertion,
angulation and removal of a bone anchor. A sleeve is provided,
which is configured to fit over the connector body in a temporary
position, in which the sleeve peimits insertion of the bone anchor,
to move to a provisional locking position in which the sleeve
permits angulation but prevents removal of the bone anchor, and to
move to a locking position, in which the sleeve prevents both
angulation and removal of the bone anchor.
SUMMARY
[0006] If a head of an anchoring element is freely pivotable with
respect to the receiving part, alignment of the receiving part and
insertion of a rod may be difficult in more complex clinical
applications, for example, when multiple bone anchors are to be
connected to the rod.
[0007] In some instances there is also a need to have a choice
between different anchoring elements during surgery, to select the
most appropriate anchoring elements for a specific clinical
application.
[0008] It is the object of the invention to provide an improved
method for assembling a bone anchoring device which can be easily
carried out, and to provide an improved tool for assembly of such a
bone anchoring device.
[0009] The receiving part according to an exemplary embodiment of
the invention allows the insertion of the head of the bone
anchoring element into the receiving part body when the locking
ring is in a first position which is an insertion position. In this
position, the locking ring is latched with respect to the receiving
part body. Therefore, the locking ring will not be inadvertently
moved to compress the head receiving portion of the receiving part
body, in order to facilitate the insertion of the head.
[0010] In a second position, which is a pre-locking position, the
locking ring is latched with respect to the receiving part body and
the head receiving portion is compressed so that the bone anchoring
element is held in an adjustable angular position but is not fully
locked. This prevents inadvertent removal of the bone anchoring
element and holds the receiving part body in an adjustable angular
position with respect to the head of the bone anchoring element.
Therefore, safe and convenient handling of the bone anchoring
device during surgery can be assured.
[0011] In a third position, which is a locking position, the
locking ring compresses the head receiving portion such that the
bone anchoring element is fully locked and cannot pivot.
[0012] The receiving part body and the locking ring may be
preassembled, and may be delivered after manufacture in a
configuration in which the locking ring is latched in the first
position to allow introduction of the head of the bone anchoring
element. A suitable bone anchoring element, for example, a bone
screw with a desired diameter and length, can be selected and
inserted into the receiving part. Thereafter, the locking ring can
be moved into the second position with respect to the receiving
part, where the head is pre-locked. The latching of the locking
ring in the receiving part body in the second position is audible,
so that a person who assembles the bone anchoring device can be
sure of correct assembly of the bone anchoring element in the
receiving part. In the pre-locked condition, the screw element may
only be pivotable with respect to the receiving part by applying an
additional force, to overcome the frictional force of the clamping
of the head.
[0013] With the bone anchoring device according to embodiments of
the invention, a modular system can be provided, which allows for
combinations of various anchoring elements with any suitable
receiving part on demand, depending on the actual clinical
requirements. This reduces the costs associated with polyaxial
screws, reduces inventory, and gives the surgeon a wide choice of
implants.
[0014] A method of assembling the bone anchoring device according
to embodiments of the invention can be carried out by any
specialist, for example, by a surgeon or any personnel assisting
him or her before or during surgery.
[0015] A tool according to embodiments of the invention is easy to
handle and provides for safer assembly of the bone anchoring
device.
BRIEF DESCRIPTION OF THE DRAWINGS
[0016] Further features and advantages of the invention will become
apparent from the description of embodiments by means of the
accompanying drawings. In the drawings:
[0017] FIG. 1 shows a perspective exploded view of a bone anchoring
device according to an embodiment of the invention;
[0018] FIG. 2 shows a perspective view of the bone anchoring device
of FIG. 1 in an assembled state;
[0019] FIG. 3 shows an enlarged perspective view of a locking ring
according to an embodiment of the invention;
[0020] FIG. 4 shows a cross-sectional view of the locking ring
shown in FIG. 3 along line A-A in FIG. 3;
[0021] FIG. 5 shows a cross-sectional view of a bone anchoring
device according to an embodiment of the invention in an assembled
state, the section being taken perpendicular to a rod axis, where
the locking ring is in a first position and is latched with respect
to the receiving part body;
[0022] FIG. 6 shows a cross-sectional view of the bone anchoring
device in an assembled state, the section being taken in a plane
perpendicular to the rod axis, where the locking ring is in a
second position and is latched with respect to the receiving part
body;
[0023] FIG. 7 shows a cross-sectional view of the bone anchoring
device in an assembled state, with a rod inserted and fixed, the
section being taken in a plane perpendicular to the rod axis, and
wherein the locking ring is in a third position;
[0024] FIG. 8 shows a cross-sectional view of a portion of the bone
anchoring device in a first step of assembly, where a bone
anchoring element is going to be inserted into the receiving
part;
[0025] FIG. 9 shows a cross-sectional view of a portion of the bone
anchoring device in a second step of assembly, where a head of the
bone anchoring element has been introduced into the receiving part
and is pre-locked;
[0026] FIG. 10 shows a cross-sectional view of a portion of the
bone anchoring device where the head is locked;
[0027] FIG. 11 shows an enlarged cross-sectional view of a portion
of the receiving part, where the locking ring is in the first
position and is latched with respect to the receiving part body to
allow for introduction of the head;
[0028] FIG. 12 shows an enlarged cross-sectional view of a portion
of the bone anchoring device in a final locked state where
additional clamping is effected by means of the locking ring;
[0029] FIG. 13 shows a perspective view of a tool for assembling a
bone anchoring device according to a first embodiment of the
invention;
[0030] FIG. 14 shows an enlarged perspective view of a portion of
the tool according to the first embodiment, with a bone anchoring
element inserted into a holder;
[0031] FIG. 15 shows a perspective view of a portion of the tool
according to the first embodiment, with a receiving part to be
inserted into a holder;
[0032] FIG. 16 shows a perspective view of a portion of the tool
according to the first embodiment, with the receiving part
introduced into the holder;
[0033] FIG. 17a shows a perspective view of the tool according to
the first embodiment depicting a step of assembly, where the head
of the bone anchoring element is going to be inserted into the
receiving part;
[0034] FIG. 17b shows an enlarged view of a portion of FIG.
17a;
[0035] FIG. 18a shows a perspective view of the tool according to
the first embodiment depicting another step of assembly, with the
head of the bone anchoring element inserted into the receiving
part;
[0036] FIG. 18b shows an enlarged portion of FIG. 18a;
[0037] FIG. 19 shows an enlarged perspective view of a portion of
the tool according to the first embodiment with the bone anchoring
device after insertion of the head and before entering the
pre-locking position;
[0038] FIG. 20 shows a perspective view of the tool according to
the first embodiment with the bone anchoring device in the
pre-locking position;
[0039] FIG. 21 shows a perspective view of an enlarged portion of
the tool according to the first embodiment, where the locking ring
of the bone anchoring device has assumed the pre-locking position
and clamps the head;
[0040] FIG. 22 shows a perspective view of a tool for assembling
the bone anchoring device according to a second embodiment of the
invention;
[0041] FIG. 23 shows a perspective view of a second holder
according to the second embodiment;
[0042] FIG. 24 shows a perspective exploded view of the second
holder according to the second embodiment;
[0043] FIG. 25a shows a cross-sectional view of the second holder
in a first position according to the second embodiment;
[0044] FIG. 25b shows a cross-sectional view of the second holder
in a second position according to the second embodiment;
[0045] FIG. 26a shows a perspective view of a portion of the tool
in a first position of use according to the second embodiment;
[0046] FIG. 26b shows a perspective view of a portion of the tool
in a second position of use according to the second embodiment;
[0047] FIG. 26c shows a perspective view of a portion of the tool
in a third position of use according to the second embodiment;
[0048] FIG. 27 shows a cross-sectional view of a portion of the
tool according to the second embodiment in the first position of
use;
[0049] FIG. 28a shows a cross-sectional view of an enlarged portion
of the tool in the first position of use according to the second
embodiment;
[0050] FIG. 28b shows a cross-sectional view of an enlarged portion
of the tool in the second position of use according to the second
embodiment;
[0051] FIG. 28c shows a cross-sectional view of an enlarged portion
of the tool in the third position of use according to the second
embodiment;
[0052] FIG. 29 shows a perspective view of a tool according to a
third embodiment of the invention, depicting a step of assembly
where the head of the bone anchoring element is to be inserted into
the receiving part;
[0053] FIG. 30a shows an insert for a first holder according to the
third embodiment, in the form of a cylindrical section having
several cylinder-shaped or U-shaped recesses;
[0054] FIG. 30b shows a first holder according to the third
embodiment;
[0055] FIG. 31 shows the first holder and the insert in an
assembled state according to the third embodiment;
[0056] FIG. 32 shows a cross-sectional view of the insert according
to the third embodiment; and
[0057] FIG. 33 shows a cross-sectional view of a frame, the first
holder, and the insert, the assembly holding a screw according to
the third embodiment.
DETAILED DESCRIPTION
[0058] As shown in FIGS. 1 to 7, a bone anchoring device according
to an embodiment of the invention includes a bone anchoring element
1 in the form of a bone screw having a threaded shaft 2 and a head
3 with a curved surface portion. In this embodiment the head 3 is
spherical segment-shaped. The head 3 has a recess 4 for engagement
with a tool. The bone anchoring device also includes a receiving
part body 5 for receiving a rod 6 to connect it to the bone
anchoring element 1. Further, a fixation element 7 in the form of
an inner screw is provided for fixing the rod 6 in the receiving
part body 5. The bone anchoring device also includes a locking ring
8 for locking the head 3 in the receiving part body 5.
[0059] The receiving part body 5 includes a rod receiving portion
9, which is substantially cylindrical and which has a first end 9a
and a second end 9b opposite the first end 9a. A coaxial first bore
10 is provided at the second end 9b as shown in FIGS. 5 to 7. The
diameter of the first bore 10 is smaller than the diameter of the
head 3 of the bone anchoring element 1. The rod receiving portion 9
further has a coaxial second bore 11 extending from the first end
9a to a distance from the second end 9b. The diameter of the second
bore 11 is larger than that of the first bore 10. A substantially
U-shaped recess 12 extends from the first end 9a in the direction
of the second end 9b in the rod receiving portion 9, the diameter
of the recess 12 being slightly larger than the diameter of the rod
6 in such a way that the rod 6 can be placed in the recess 12 and
can be guided therein. By means of the recess 12, two free legs
12a, 12b are formed on which an internal thread 13 is provided. The
internal thread 13 can be a metric thread, a flat thread, a
negative angle thread, a saw-tooth thread, or any other type of
thread. Preferably, a thread such as a flat thread or negative
angle thread is used, which prevents splaying of the legs 12a, 12b
when the inner screw 7 is screwed-in. The depth of the recess 12 is
such that the rod 6 and the inner screw 7 can be inserted between
the legs 12a and 12b.
[0060] As can be seen in FIG. 1, cut-outs 15 are provided in the
rod receiving portion 9 on either end of the channel formed by the
recess 12.
[0061] On an outer surface of the rod receiving portion 9, in the
region of the legs 12a, 12b, a groove 16 is provided, which extends
in a circumferential direction and serves for engagement with a
portion of the locking ring 8. The groove 16 is asymmetric in such
a way that it allows for disengagement between the locking ring 8
and the groove 16 when the locking ring 8 is shifted in one
direction. The asymmetric shape of the groove 16 is realized by a
downwardly inclined lower wall 16a and an upper wall 16b that is
substantially perpendicular to an outer surface of the rod
receiving portion 9.
[0062] At the side of the second end 9b the receiving part body 5
has a head receiving portion 17 providing an accommodation space
for the head 3 of the bone anchoring element 1. A largest outer
diameter of the head receiving portion 17 is smaller than a largest
outer diameter of the rod receiving portion 9. An internal hollow
section 18 forms a seat for the head 3 of the bone anchoring
element 1, and is open via an opening 19 to a free end 17b of the
head receiving portion 17. The hollow section 18 corresponds in its
shape to the shape of the head 3. In the embodiment shown, the
hollow section 18 is a spherical section to accommodate the
spherical head 3. Furthermore, the hollow section 18 is configured
to encompass the head 3 of the bone anchoring element 1 from the
side, covering a region including the largest diameter of the head
3.
[0063] A plurality of slits 20 are provided in the head receiving
portion 17, which are open to the free end 17b. The slits 20 make
the head receiving portion 17 flexible so that it can be compressed
to clamp and finally lock the head 3 in the hollow internal portion
18 by means of friction. The number and size of slits 20 is
provided depending on the desired flexibility of the head receiving
portion 17. The flexibility of the head receiving portion 17 is
such that the head 3 of the anchoring element 1 can be inserted by
expanding the head receiving portion 17, and the head 3 can be
clamped by compressing the head receiving portion 17.
[0064] The outer surface of the head receiving portion 17 has a
first section 21, with an outer diameter which increases towards
free end 17b, for example in an outwardly curved or conically
widening manner. Adjacent to the first section 21, there is a
circumferential groove 22, which is recessed with respect to the
first section 21 and which serves for engagement with a
corresponding portion of the locking ring 8. The groove 22 is
asymmetric to allow for disengagement between the locking ring 8
and the groove 22 when moving the locking ring 8 in one direction.
The asymmetric shape of the groove 22 is realized by a lower
downwardly inclined wall 22a and an upper wall 22b that is
substantially perpendicular to an outer surface of the head
receiving portion 17.
[0065] Adjacent the groove 22 on a side opposite the first section
21, there is a third portion 23 of the head receiving portion 17
with a substantially cylindrical outer surface. The third portion
23 is configured to cooperate with a portion of the locking ring 8
to enhance the clamping effect of the locking ring 8.
[0066] The locking ring 8 will now be described with reference to
FIGS. 1 to 7. The locking ring 8 is substantially cylindrical and
has an upper end 8a and a lower end 8b. In the mounted state the
upper end 8a is oriented in the direction of the first end 9a of
the rod receiving portion 9, while the lower end 8b is oriented
towards the free end 17b of the head receiving portion 17. Near the
lower end 8b, a first portion 81 with an inner surface 81a is
provided which cooperates with the first outer surface portion 21
of the head receiving portion 17 to compress the head receiving
portion 17. The outer surface of the first portion 81 may also be
tapered to reduce an outer bottom diameter. The size of the first
portion 81 is such that, for example, the tapered inner surface 81a
can engage the outer surface portion 21 of the head receiving
portion 17 to exert a compression force onto the head receiving
portion 17. The inner surface 81a of the first portion 81 of the
locking ring 8 can also be curved with a curvature directed towards
a center of the locking ring 8.
[0067] At the lower end 8b, the locking ring 8 includes an inwardly
projecting edge 82, the inner diameter of which is smaller than the
inner diameter of the other portions of the locking ring 8. The
inwardly projecting edge 82 is configured to engage the groove 22
of the head receiving portion 17.
[0068] The locking ring 8 further has a third portion 83 with
upwardly extending wall portions 83a, which are separated from each
other by slits 84. The upwardly extending wall portions 83a are
arranged at an outer circumference of an inner circumferential
shoulder 85 of the locking ring 8, and render the third portion 83
of the locking ring 8 flexible. The number and size of the slits 84
and the thickness of the wall portions 83a are configured such that
a desired flexibility is realized. At the free ends of the wall
portions 83a are engagement sections 83b which are shaped so as to
engage the groove 16 provided on the outer surface of the rod
receiving portion 9. The inner diameter of the third portion 83 of
the locking ring 8 is only slightly larger than the outer diameter
of the rod receiving portion 9, as can be seen in FIG. 5.
[0069] The locking ring 8 is sized in such a way with respect to
the head receiving portion 17, that the head receiving portion 17
can expand within the locking ring 8 to allow the introduction of
the head 3 when the locking ring 8 is in the first position, as
shown in FIG. 5.
[0070] Two projections 86, which are located diametrically opposite
to each other, are formed in the third portion 83 of the locking
ring 8. The projections 86 have a height where they extend into the
cut-outs 15 and project above the bottom of the substantially
U-shaped recess 12 when the locking ring 8 is in a position in
which the head 3 is not yet locked, as shown in FIGS. 5 and 6. A
free end surface 86a of the projections 86 can be curved,
particularly inwardly curved, with a curvature corresponding to an
outer surface of the rod 6. The locking ring 8 is arranged in such
a manner around the head receiving portion 17 of the receiving part
body 5, that the projections 86 are located at the positions of
(e.g., are aligned with) the recess 12. Here, the projections 86
prevent the locking ring 8 from rotating when the rod 6 is not
inserted.
[0071] The flexibility of the head receiving portion 17 and the
size of the head receiving portion 17 at the open end 17b allows
for mounting of the locking ring 8 by assembling the locking ring 8
from the free end 17b onto the head receiving portion 17. Since the
outer diameter of the head receiving portion 17 is smaller than
that of the rod receiving portion 9, the locking ring 8 may only
project minimally beyond the rod receiving portion 9 in a radial
direction.
[0072] The inner screw 7 has a thread corresponding to the internal
thread 13 provided on the legs 12a, 12b. If a thread, which
prevents the legs 12a, 12b from splaying is used, a single fixation
element such as the inner screw 7 is sufficient. This reduces the
size of the bone anchoring device in a radial direction. Other
fixation elements such as, for example, an outer nut are also
possible.
[0073] The receiving part body 5, the locking ring 8, the inner
screw 7 and the bone anchoring element 1 are made of bio-compatible
materials, for example, titanium or stainless steel or a
bio-compatible alloy such as nitinol or a bio-compatible plastic
material, such as polyether ether ketone (PEEK). The parts can be
made of the same or of different materials.
[0074] The function of the locking ring 8 is now explained with
referenced FIGS. 5 to 12. As shown in FIG. 5, the locking ring 8 is
in a first position, which is an insertion position and where the
locking ring 8 is latched with respect to the receiving part body
5. In the first position, the inwardly projecting edge 82 of the
locking ring 8 engages groove 22 on the outer surface of the head
receiving portion 17. As can be seen in the figures, the inner
diameter of the inwardly projecting edge 82 is larger than the
outer diameter of the head receiving portion 17 at the position of
the groove 22, so as to allow for expansion of the head receiving
portion 17 when the head 3 is introduced. In the first position,
the locking ring 8 is additionally held by a clamping force between
the rod receiving portion 9 of the receiving part body 5 and the
flexible wall portions 83a of the locking ring 8, which are
slightly bent outwards, as can be seen in particular in FIGS. 5, 8,
and 11.
[0075] When the locking ring 8 is in the first position, the head
receiving portion 17 is not compressed. In this position, the
introduction of the screw head 3 is possible as can be seen in FIG.
8. In the first position, the locking ring 8 is prevented from
moving upwards towards the first end 9a of the rod receiving
portion 9, since the shoulder 85 of the locking ring 8 abuts
against the second end 9b of the rod receiving portion 9b, while
the inwardly projecting edge 82 of the locking ring 8 abuts against
the upper wall 22b of groove 22. As shown in particular in FIG. 8,
the abutment of the locking ring 8 against the second end 9b and
against the upper wall of groove 22 holds the locking ring 8 in
place against upward movement. The inclined lower wall 22a of the
groove 22 prevents inadvertent downward movement of the locking
ring 8 but allows downward movement of the locking ring 8, upon
exertion of an additional force. Since portions of the inner
diameter of the locking ring 8 are larger than corresponding
portions of the outer diameter of the head receiving portion 17 in
a non-compressed state in the first position, an expansion of the
head receiving portion 17 into a space between the locking ring 8
and the head receiving portion 17 is possible. In addition, in the
first position, the head 3 can freely pivot.
[0076] FIGS. 6 and 9 illustrate the bone anchoring device in a
second position in which the locking ring 8 is latched with respect
to the receiving part body 5 in a pre-locking position. In the
second position, the locking ring 8 has been shifted from the first
position towards the free end 17b of the head receiving portion 17
until the engagement portions 83b of the flexible wall portions 83a
resiliently snap into the groove 16 provided on the rod receiving
portion 9. Once in the second position, the free upper edge of the
engagement portions 83b will abut against the upper wall 16b of the
groove 16, as shown in FIGS. 6 and 9, thereby preventing upward
movement of the locking ring 8 out of the pre-locking position. On
the other hand, the inclined lower wall surface 16a of the groove
16 prevents inadvertent downward movement of the locking ring 8
towards the free end 17b, but allows for downward movement upon
exertion of an additional force.
[0077] In the second position, as can be seen in particular in
FIGS. 6 and 9, the inner inclined surface 81a of the locking ring 8
presses against the first outer surface portion 21 of the head
receiving portion 17, so as to compress the head receiving portion
17 to clamp the head 3 within the hollow internal portion 18
without fully locking the head 3. In addition, the inwardly
projecting edge 82 of the locking ring 8 presses against the third
portion 23 of the head receiving portion 17, resulting in an
additional clamping force. Therefore, clamping of the head 3 can be
effected not only from above and/or the sides of the head 3, but
also from a region around the lower portion of head 3. Pre-locking
means that under conditions arising during surgery, the angular
position of the bone anchoring element 1 with respect to the
receiving part body 5 is maintained, and can be loosened only by
exerting an additional force onto the receiving part body 5 and/or
the bone anchoring element 1 of the bone anchoring device. In the
pre-locked position, the bone anchoring element 1 cannot be removed
from the receiving part 5. Hence, accidental or inadvertent removal
of the head 3 is not possible. However, angulation of the bone
anchoring device to be adjusted to a desired angle is still
possible, for example, by manual adjustment.
[0078] A third position, which is the locking position, is shown in
FIGS. 7, 10, and 12. The third position is defined as a position in
which the screw head 3 is finally locked within the head receiving
portion 17. The inner surface 81a of the locking ring 8 engages the
outer surface of the first portion 21 of the head receiving portion
17 in such a way that the head 3 is locked by compression of the
head receiving portion 17. In addition, the inwardly projecting
edge 82 of the locking ring 8 further compresses the head receiving
portion 17 at the third portion 23, thereby enhancing the locking
force.
[0079] The dimensions of the receiving part body 5 and the locking
ring 8 are configured such that desired clamping forces can be
achieved in the second position and in the third position,
respectively.
[0080] The third position can be reached by shifting the locking
ring 8 relative to the receiving part body 5 such that the
engagement portions 83b and the inwardly projecting ring 82 slide
along the lower inclined wall portions 16a and 22a of the grooves
16, 22, respectively.
[0081] The bone anchoring device is preassembled as follows. First,
the locking ring 8 is mounted onto the receiving part body 5 from
the free end 17b. This can be done, for example, by the
manufacturer. Preferably, the locking ring 8 is in the first
position, where it is latched by engagement or alignment of the
inwardly projecting edge 82 with the groove 22.
[0082] Thereafter, the head 3 of the anchoring element 1 can be
introduced from the free end 17b into the hollow internal portion
18 of the head receiving portion 17. Thereafter, the locking ring 8
is moved downwards relative to the receiving part body 5, so that
the inwardly projecting ring 82 slides out of the groove 22 and the
engagement portions 83b of the flexible wall portions 83a snap into
groove 16, to reach the second position, in which the head 3 is
pre-locked by frictional clamping.
[0083] A tool for assembling the bone anchoring device and its
operation according to a first embodiment will now be described
with reference to FIGS. 13 to 21. The tool 100 includes a frame 101
with a first holder 102 for the bone anchoring element 1 and a
second holder 103 for the receiving part (including, for example,
the receiving part body 5 and the locking ring 8). The holders 102,
103 are oriented such that a longitudinal axis of the bone
anchoring element 1 is horizontal or parallel with respect to a
surface on which the tool is placed or positioned. The first holder
102 has a recess 102a for the shank 2 of the bone anchoring element
1, which serves for holding and guiding the shank 2. The diameter
of the recess 102a is smaller than the diameter of the head 3 in
the area of a free end of the first holder 102 facing the second
holder 103. Therefore, a free end surface 102b of the first holder
102 serves as an abutment for the head 3 of the bone anchoring
element 1. The first holder 102 is supported on the frame 101.
[0084] The second holder 103 for the receiving part is also
supported on the frame 101. It has a substantially circular recess
103a for accommodating a portion of the receiving part. The
orientation of the second holder 103 with respect to the first
holder 102 is such that a central axis of the receiving part is
configured to be positioned coaxial with the axis of the bone
anchoring element 1 when the receiving part and the bone anchoring
element 1 are both inserted into their respective holders 102, 103.
The circular recess 103a can be adjusted to have two different
depths. This may be realized by an insert 104 which is inserted in
a corresponding slot provided in the second holder 103 and which
can be shifted in a direction transverse to the direction of the
central axis of the recess 103a, to limit the depth of recess 103a.
The insert 104 has one circular recess 142. In position 1, as shown
in FIGS. 13 to 18, the insert limits the depth of the recess 103a
to a first depth 141, and thus provides an abutment for the first
end 9a of the receiving part body 5. In position 2, which is shown
in FIGS. 19 to 21, the insert 104 is shifted such that its recess
142 forms or defines the bottom of the recess 103a of the second
holder 103, the depth of which is greater than the depth 141 of the
recess 103a when the insert 104 is in the first position. As such,
the recess 142 effectively increases the length of the recess 103a.
The receiving part can therefore be inserted deeper into the recess
103a until an outer surface 103b of the second holder 103 forms an
abutment for the locking ring 8, as shown in FIGS. 19 to 21. The
shape of the recess 103a need not be circular, but can be otherwise
shaped, and in particular, it can be adapted to correspond to the
contour of the receiving part.
[0085] The first holder 102 for the bone anchoring element 1 is
movable relative to the second holder 103 for the receiving part
body 5 in an axial direction. The first holder 102 can be actuated
via a lever 105 and a handle 106. It is to be understood that the
lever 105 is only an example, and that movement of the first holder
102 for the bone anchoring element 1 can be effected in many other
ways, for example, by means of a toothed rack.
[0086] The dimensions of the tool 100 are configured such that, by
movement of the first holder 102 for the bone anchoring element 1
with respect to the second holder 103 in which a receiving part is
inserted, a sufficient force can be exerted to introduce the head 3
of the bone anchoring element 1 into the head receiving portion 17,
when the recess 103a is set to have the first depth 141 and the
locking ring 8 is in the first position. It is further configured
such that a sufficient force can be exerted onto the locking ring 8
when first holder 102 is moved again relative to the second holder
103 to move the locking ring 8 out of the first position into the
second position, when the recess 103a is set to have the second
depth 142.
[0087] The operation of the tool according to the first embodiment
is shown in FIGS. 17 to 21. As shown in FIGS. 17a and 17b first,
the bone anchoring element 1 is inserted into the first holder 102
and the receiving part body 5, with mounted locking ring 8 in the
first position, is mounted in the recess 103a of the second holder
103 when the recess 103a is set to have the first depth 141.
[0088] In a next step, as shown in FIGS. 18a and 18b, the handle
106 is actuated to actuate the lever 105 so that screw head 3 is
pushed into the hollow internal portion 18 of the head receiving
portion 17. The bottom of the recess 103a of the second holder 103
serves as an abutment for the receiving part, so that the head
receiving portion 17 can expand to allow the introduction of the
head 3. The handle 106 is actuated until the head 3 of the bone
anchoring element 1 is latched or inserted in the hollow internal
portion 18. The latching may produce an audible sound.
[0089] Thereafter, as shown in FIGS. 19 to 21, the first holder 102
for the bone anchoring element 1 is shifted backward and the insert
104 is moved to the second position, in which the circular recess
142 forms or defines the bottom of recess 103a to provide and use
outer surface 103b of holder 103 as an abutment for the locking
ring 8.
[0090] As shown in FIGS. 20 and 21, the handle 106 is then actuated
to push the first holder 102 towards the second holder 103. By
means of this, the head 3 with the receiving part body 5 is pushed
farther into the bottom of the recess 103a, which has a depth where
the free front surface 103b of the second holder 103 presses
against the engagement portions 83b of the flexible wall portions
83a of the locking ring 8, thereby moving the locking ring 8 out of
the first position into the second position, where the engagement
portions 83b are latched in the groove 16 on the rod receiving
portion 9. When the engagement portions 83b snap into the groove
16, the latching of the locking ring 8 with respect to the
receiving part body 5 is audible, which indicates that the correct
pre-locking position is reached.
[0091] Thereafter, the first holder 102 is moved backward and the
bone anchoring device is removed.
[0092] A tool for assembling the bone anchoring device and its
operation according to a second embodiment will now be described
with reference to FIGS. 22 to 28c. As can be seen from FIG. 22, the
tool 200 includes a frame 201 with a first holder 202 for the bone
anchoring element 1 and a second holder 203 for the receiving part
(again including, for example, the receiving part body 5 and the
locking ring 8). The tool 200 according to the second embodiment
only differs from the tool 100 according to the first embodiment in
that the second holder 203 is different from the second holder 103
according to the first embodiment. The holders 202, 203 may be
oriented such that a longitudinal axis of the bone anchoring
element 1 is horizontal or parallel with respect to a surface on
which the tool is placed or positioned. The holder 202 has a recess
202a for the shank 2 of the bone anchoring element 1, which serves
for holding and guiding the shank 2. The diameter of the recess
202a is smaller than the diameter of the head 3 in the area of a
free end of the first holder 202 facing the second holder 203.
Therefore, a free end surface 202b of the first holder 202 serves
as an abutment for the head 3 of the bone anchoring element 1. The
first holder 202 is supported on the frame 201.
[0093] The second holder 203 for the receiving part is also
supported on the frame 201. The orientation of the second holder
203 with respect to the first holder 202 is such that a central
axis of the receiving part is configured to be positioned coaxial
with the axis of the bone anchoring element 1 when the receiving
part and the bone anchoring element 1 are both inserted into their
respective holders 202, 203.
[0094] The first holder 202 for the bone anchoring element 1 is
movable relative to the second holder 203 for the receiving part
body 5 in an axial direction. The first holder 202 can be actuated
via a lever 205 and a handle 206. It is to be understood that the
lever 205 is only an example, and that movement of the first holder
202 for the bone anchoring element 1 can be effected in many other
ways, for example, by means of a toothed rack.
[0095] As can be seen from FIG. 23 the second holder 203 includes a
main body 210, a first end 211, a second end 212, a bore 220, and a
substantially circular recess 203a for accommodating a portion of
the receiving part. As can be seen from FIG. 24 the second holder
203 further includes a thread 213, a sleeve 214, a spring 215, a
plate 216 and a screw 217. As can be seen from FIGS. 25a and 25b,
the cup-shaped sleeve 214 is closed on a side extending towards the
first end 211 and is configured to slide within the bore 220 of the
main body 210 since its diameter is slightly smaller than the inner
diameter of at least a portion of the bore 220. The spring 215 is
provided within the sleeve 214 and is supported by the plate 216
and the inner screw 217 which is screwed into the thread 213 of the
main body 210. Other designs for supporting the spring 215 are
possible, such as for example, a base which is press-fitted into
the second holder 203. The spring 215 is shown as a helical spring
215 in the second embodiment. However other spring elements are
possible, such as leaf springs, disk springs, elastomer cushions,
etc.
[0096] The circular recess 203a can have varying depths. This is
realized by the movable sleeve 214 which provides an abutment for
the receiving part. In FIG. 25a a first abutment position and in
FIG. 25b a second abutment position are shown, where a space 218 is
shown in FIG. 25b when the spring 215 is compressed. The sleeve 214
provides an abutment for the first end 9a (see FIG. 1) of the
receiving part body 5. In the first abutment position, the closed
side of the sleeve 214 forms the bottom of the recess 203a of the
second holder 203, the depth of which is less than a depth of the
recess 203a in the second abutment position that is achieved when a
greater force is applied by the first end 9a of the receiving part
onto the sleeve 214 and the spring 215, respectively. The force is
exerted by the handle 206 and the lever 205 via the first holder
202, the shaft 2 and the head 3 to the first end 9a of the
receiving part and then to the sleeve 214. The shape of the recess
203a need not be circular, but can be otherwise shaped, and in
particular, it can be adapted to correspond to any possible contour
of the receiving part.
[0097] The dimensions of the tool 200 and the spring force are
configured such that, by means of moving the first holder 202 with
the bone anchoring element 1 relative to the second holder 203 in
which a receiving part is inserted, a first force can be exerted to
introduce the head 3 of the bone anchoring element 1 into the head
receiving portion 17, when the recess 203a is set to have the first
depth and the locking ring 8 is in the first position. It is
further configured such that a second force can be exerted onto the
locking ring 8 when the first holder 202 is moved closer relative
to the second holder 203 to move the locking ring 8 out of the
first position into the second position, where the recess 203a has
the second depth. The tool 200 according to the second embodiment
of the invention allows for mounting of various bone anchoring
devices with, for example, receiving parts having different heights
and/or various different locking ring positions relative to the
receiving part.
[0098] The operation of the tool according to the second embodiment
is shown in FIGS. 26a to 28c. As shown in FIGS. 26a, 27 and 28a
first, the bone anchoring element 1 is inserted into the first
holder 202 and the receiving part body 5, with mounted locking ring
8 in the first position, is mounted in the recess 203a of the
second holder 203 when the recess is set to have the first
depth.
[0099] In a next step, as shown in FIGS. 26b and 28b, the handle
206 is actuated to actuate the lever 205 (see FIG. 22) so that the
screw head 3 is pushed into the hollow internal portion 18 (see
FIG. 5) of the head receiving portion 17. The bottom of the recess
203a of the second holder 203, i.e. the sleeve 214, serves as an
abutment for the receiving part, so that the head receiving portion
17 can expand to allow the introduction of the head 3. The handle
206 is actuated until the head 3 of the bone anchoring element 1 is
latched or inserted in the hollow internal portion 18. The latching
may produce an audible sound. The locking ring 8 may not yet
contact a side wall of the first end 211. The counterforce of the
spring 215 is greater than the counterforce from insertion of the
head 3 into the receiving part body 5. Therefore, the spring 215 is
not compressed during this step.
[0100] As shown in FIGS. 26c and 28c, the handle 206 is then
actuated further to push the first holder 202 closer to the second
holder 203. By means of this, the head 3 with the receiving part
body 5 is pushed against the bottom of the recess 203a, i.e. the
sleeve 214. The force which is needed for moving the locking ring 8
and the receiving part body 5 relative to each other is greater
than the counterforce from the spring 215. Therefore, the spring
215 is compressed. The recess 203a now has a depth where the side
wall of the first end 211 of the second holder 203 presses against
the engagement portions 83b of the flexible wall portions 83a of
the locking ring 8 (see FIG. 3), thereby moving the locking ring 8
out of the first position into the second position, where the
engagement portions 83b are latched in the groove 16 on the rod
receiving portion 9. When the engagement portions 83b snap into the
groove 16, the latching of the locking ring 8 with respect to the
receiving part body 5 is audible, which indicates that the correct
pre-locking position is reached.
[0101] Thereafter, the first holder 202 is moved backward and the
bone anchoring device is removed. One advantage of the second
embodiment of the tool 200 as compared to the first embodiment of
the tool 100 is that only a singe actuation of the handle 206 is
needed, and no additional parts have to be moved during the
mounting of the bone anchoring device.
[0102] By means of the tool 200 according to the second embodiment,
assembly of the bone anchoring device can be easily completed in
one step, including the introduction of the head and the mounting
of the bone anchoring device into the pre-lock position.
[0103] A third embodiment of a first holder 302 for the bone
anchoring element will now be described with reference to FIGS. 29
to 33. The tool 300 shown in FIG. 29 can be the same or have
similar features to the tools 100 or 200 described above, except
for the first holder 302 which replaces the first holders in the
previous embodiments.
[0104] The first holder 302, shown in FIGS. 30b and 31, has a
longitudinal U-shaped recess 302i which referring to FIG. 30b,
extends from one end towards another end in a longitudinal
direction and from the side of the first holder 302 inwards. The
diameter of the recess 302a is smaller than the diameter of a head
3 of a bone anchoring element 1 in the area of a free end of the
first holder 302 facing a second holder 303. Therefore, a free end
surface 302b of the first holder 302 serves as an abutment for the
head 3 of the bone anchoring element 1. The first holder 302 is
supported on the frame 301.
[0105] FIG. 30a and FIG. 32 show an insert 320 for the first holder
in the form of a cylindrical section having a plurality of
longitudinally extending recesses 322a, 322b, 322c that are
arranged circumferentially around a central axis 323 of the insert
320. The recesses are sized and/or adapted for the insertion of
screws or other bone anchoring elements with different shanks. In
the embodiment shown the insert 320 has a first cylinder-shaped or
U-shaped recess 322a having a first radius, a second
cylinder-shaped or U-shaped recess 322b having a second radius and
a third cylinder-shaped or U-shaped recess 322c having a third
radius, wherein the three radii may be different from each other.
The three recesses 322a, 322b, 322c may extend the length of the
insert 320, as can be seen from FIG. 30a. The insert 320 has a
first end and a second end, wherein a first pin 321a is provided on
the first end and a second pin 321b is provided on the second end.
The pins 321a, 321b are in line with the central axis 323 of the
insert 320.
[0106] Referring to FIG. 30b, the first holder 302 has a first end
and a second end, where on the first end a first slot 311 is
provided and near the second end a second slot 312 is provided
which both extend from a side of the first holder 302 inwards. The
second end of the first holder 302 is configured to be connected to
a lever 305 and a handle 306 of the tool, as can be seen in FIG.
29.
[0107] The U-shaped recess 302a of the first holder 302 is provided
for receiving the insert 320. The radius of the circular portion of
the U-shaped recess 302a may be substantially the same as the
radius of the insert 320.
[0108] As can be seen from FIG. 31, in a mounted state, the first
pin 321a of the insert 320 fits into the first slot 311 of the
first holder 302, and the second pin 321b of the insert 320 fits
into the second slot 312 of the first holder 302. The insert 320 is
supported and guided by the pins 321a, 321b, and is also held by
the U-shaped recess 302a of the first holder 302 as can be seen in
FIG. 33.
[0109] The orientation of the first holder 302 with respect to a
second holder 303 is such that a central axis of a receiving part 5
is configured to be positioned coaxial with an axis of the bone
anchoring element 1 when the receiving part 5 is inserted into the
second holder 303 and the bone anchoring element 1 is inserted into
the first holder 302 in one of the recesses 322a, 322b or 322c of
the insert 320.
[0110] The three recesses 322a, 322b or 322c are adapted to receive
different sized shanks of bone anchoring elements. With reference
to FIGS. 29, 31, and 33, a particular recess 322a, 322b, 322c which
is in use will face outwards towards the opening of the U-shaped
recess 302a. In this embodiment of the insert 320, mounting of at
least three different sized bone anchoring elements can be
accommodated. For changing the recess 322a, 322b, 322c which is in
use, the insert 320 can be rotated around its axis 323.
[0111] In other embodiments, a cylinder or insert having more or
less than three recesses can be provided. With the third embodiment
of the holder, a user can combine screws or bone anchoring elements
with different shanks to a receiving part. Hence, a modular system
is provided that gives the user a wider selection of implant
combinations depending on the actual clinical situation.
[0112] The bone anchoring device can be preassembled either by the
manufacturer or in the course of preparation of surgery or at any
other time. Advantageously, the surgeon can select prior to surgery
the desired receiving parts and bone anchoring elements according
to the specific requirements of the particular clinical
application. The design of the bone anchoring device allows for
slection of the appropriate bone anchoring elements in terms of
diameter, length and other features of the anchoring section.
Hence, a modular system can be provided, which includes receiving
parts and various bone anchoring elements, which then can be
individually chosen and adapted.
[0113] In use during surgery, the preassembled bone anchoring
device including the receiving part body 5, the bone anchoring
element 1 and the locking ring 8 in the pre-locking position, is
screwed into a bone. The recess 4 of the head 3 can be accessed
with a screw tool through the first bore 10. To correctly align the
receiving part body 5 with respect to the rod 6, to which it will
be connected, an additional force can be exerted onto the receiving
part, either manually or by application of an instrument. Once the
correct position of the rod 6 with respect to other bone anchoring
devices is also achieved, the inner screw 7 can be tightened for
each bone anchoring device. Since the rod 6 abuts against the
projections 86 of the locking ring 8, the locking ring 8 is shifted
downward into the third position, which is the locking position.
When the locking ring 8 is moved towards the free end 17b of the
head receiving portion 17, it compresses the head receiving portion
17, thereby locking a position of the head 3. Final tightening of
the inner screw 7 locks the rod 6 and the head 3
simultaneously.
[0114] In the pre-locking condition, the head 3 remains clamped
when the inner screw 7 is loosened. This allows further adjustments
with respect to positioning of the rod 6.
[0115] Further modifications of the embodiments shown are possible.
For example, the head of the bone anchoring element can have any
other shape, for example, a cylindrical shape, whereby a monoaxial
bone screw is provided, allowing rotation of the screw element with
respect to the receiving part body around a single axis. The head
can also be conically shaped or otherwise shaped, and the internal
hollow section of the head receiving portion is adapted to
correspond to this shape. In a further modification, the
flexibility of the head receiving portion is based on properties of
the material, for example, a plastic material, and the slits may be
fully or partly omitted.
[0116] The projections of the locking ring which engage the rod can
have another shape, for example, the surface of the free end can be
flat or can be otherwise shaped. Alternatively, the projections can
be omitted.
[0117] The head receiving portion can have an inclined open end, or
can be otherwise asymmetric to allow for a greater angulation of
the head in one direction.
[0118] The outer surface of the head receiving portion and the
inner surface of the locking ring can have other shapes which allow
for compression of the locking ring by means of an increasing force
when the locking ring is shifted downwards relative to the
receiving part body.
[0119] With respect to the tool, variations are also possible. For
example, the tool can be configured such that the screw axis and
the central axis of the receiving part extend perpendicular to the
surface on which the tool is placed or positioned. The second
holder for the receiving part body can be movable with respect to
the first holder for the bone anchoring element. In addition,
instead of a manual actuation of the tool, it may also be possible
to actuate the tool by means of a mechanically or electronically
operated device.
[0120] While the present invention has been described in connection
with certain exemplary embodiments, it is to be understood that the
invention is not limited to the disclosed embodiments, but is
instead intended to cover various modifications and equivalent
arrangements included within the spirit and scope of the appended
claims, and equivalents thereof.
* * * * *